posed treatment, as well as a reasonable explanation of the viable alternative treatments that can be made available in a prison setting.

White v. Napoleon12

The right has never been regarded as absolute, however, (see Comm’n of Correction v. Myers);13 and it may be overridden if there are strong public health reasons to administer treatment, as when the Supreme Court upheld mandatory smallpox vaccination in 1905, despite the patient’s religious objections (Jacobson v. Massachusetts).14 Inmates have been required, for example, to submit to blood and tuberculosis tests and to diphtheria and tetanus injections (Thompson v. City of Los Angeles; Zaire v. Dalsheim; Ballard v. Woodard).15 Involuntary administration of antipsychotic medication has also been upheld when accompanied by appropriate clinical findings and procedural protections for the inmate patient (Washington v. Harper).16

Summary of Findings on Changing Demographics and Health Issues

  • The correctional population has expanded more than 4.5 fold between 1978 and 2004—from 1.5 million to almost 7 million. Prisons and jails house 2.1 million prisoners; an additional 4.9 million are on probation and parole.

  • Distrust of the AIDS/HIV movement in the 1990s within some minority communities resulted in more skepticism about physicians and researchers. This means that there is now, compared with the 1970s, a more compelling need for collaboration among all parties (details on collaborative responsibility are presented in Chapter 5).

  • The aging of the prisoner population, the high number of prisoners with mental illness, and the poor reading and communication skills among prisoners means that there are now increased concerns about prisoners’ capability to give informed consent, calling for a greater focus than before on the informed consent process and validation of prisoner consent to test their comprehension of research disclosures (see Chapter 6).

  • Because the possibility of poor health-care delivery exists in correctional settings, new regulations should include instructions that IRBs con-


White v. Napoleon, 897 F.2d 103, 113 (3d Cir. 1990).


Commission of Correction v. Myers, 399 N.E.2d 452 (Mass. 1979).


Jacobson v. Massachusetts, 197 U.S. 11 (1905).


Thompson v. City of Los Angeles, 885 F.2d 1439 (9th Cir. 1989); Zaire v. Dalsheim, 698 F.Supp. 57 (S.D.N.Y. 1988); Zaire v. Dalsheim, 698 F.Supp. 57 (S.D.N.Y. 1988).


Washington v. Harper, 494 U.S. 210, 110 S.Ct. 1028 (1989).

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